Development of a Bariatric patient Readiness Assessment Tool (BRAT) for the Emergency Department.

The current obesity epidemic in the U.S. and the chronic conditions associated with obesity and morbid obesity, present many challenges to healthcare providers, particularly in the hospital Emergency Department (ED). EDs are often not well equipped to care for the morbidly obese patient, which presents risks to safe patient handling for both patient and provider. The purpose of this study was to develop an assessment tool to determine the readiness of the ED to care for and handle the morbidly obese patient. Currently published guidelines by the Facilities Guidelines Institute (FGI) and the National Association of Bariatric Nurses (NABN) were applied to the development of the tool. The tool assesses policy, equipment, space and structural requirements, and patient handling and moving tasks. A two phase non-experimental, exploratory study in a convenience sample of five EDs was conducted applying a usability testing model to determine the tool's usability and utility. Four of the five hospital EDs agreed the tool was easy to use and helpful in determining their readiness to safely care for the morbidly obese patient. The tool was found to be usable on a limited basis. Additional application of the tool on a larger scale is recommended.

[Key words: readiness assessment tool, morbidly obese, Emergency Department]

I. Introduction a. Problem: obesity epidemic in U.S., lack of health care organization readiness, healthcare worker safety and injury prevention b. Significance: increased awareness of need for safe patient handling policies, equipment and supportive structural design c. Relevant literature: organizational/ED readiness, safety and injury prevention, FGI: Patient Handling And Movement Assessment (PHAMA) guidelines d. Purpose of the study/project: To develop a readiness self-assessment tool for the care of the morbidly obese patient in the ED II. Methods/Design: a. Description: Non-experimental, exploratory study phase 1 - develop tool from existing standards phase 2 - test tool by administering and soliciting feedback for improvement b. Sampling/setting: convenience sample c. Human subjects protection: IRB- no human subjects d. Measures/data analysis: UsabilitylUtility III. Results: draft of final tool a. Overall usefulness of tool b. Changes made to tool IV. Discussion/Limitations a. PHAMA guidelines b. Learning points from the data suggestive of need for further research V. Implications for Advanced Practice in Emergency Nursing: Application recommendations for use of tool a. Use by Nurse Manager in the ED as a tool for safety assessment and capital budget preparation for purchase oflift equipment b. Provide foundation for APN clinical practice guideline/protocol development for planning care for morbidly obese patient population c. Apply tool to general use in the hospital, i.e. ICUs to assist with streamlining care between units. d. Adaptation of tool by ED CNS as both an assessment and teaching tool for staff e. Provide foundation for "safe patient handling" culture development for all provider levels in ED VI. Expanded application VII. Conclusion

Description

University of Maryland, Baltimore. Doctor of Nursing Practice Scholarly Project

Keyword

morbidly obese patients
emergency care
instrument construction
bariatric patient readiness assessment tool (BRAT)
Emergency Service, Hospital--standards
Obesity, Morbid

Identifier to cite or link to this item

http://hdl.handle.net/10713/2331